Key result
Only ~11% of patients with hypertension in rural Bihar receive care from quality local providers.
Why the study?
Effective hypertension management in low- and middle-income settings remains a persistent challenge, and supply- and demand-side barriers to quality care were examined in rural Bihar, India.
Cross-Sectional (n=14,386)
Yes
The quality of hypertension management services in rural Bihar is severely inadequate, with only 10.9% of diagnosed patients receiving high-quality care locally, driving many to bypass local providers.
Indicates substantial gaps in rural hypertension care quality; leaves open optimal interventions to improve provider performance and access.
Effective management of hypertension in low- and middle-income settings is a persistent public health challenge. This study examined supply- and demand-side barriers to receiving quality care and achieving effective hypertension management in rural Bihar, India. A state-representative household survey collected information from adults over 30 years of age on characteristics of the hypertension screening, diagnosis, and management services they received. A linked provider assessment determined the percent of providers who provided quality hypertension care (i.e., had a functioning BP measurement device, measured a patient's BP, could correctly diagnose hypertension, had at least one first-line antihypertension medication, and could prescribe correctly based on standard guidelines). Patients were linked with their provider to determine the quality-adjusted coverage of hypertension management and logistic regression analysis was conducted to determine characteristics associated with receiving quality care. A total of 14,386 patients and 390 providers were studied. Nearly a quarter (22.5%) of adults had never had their BP measured before and 8.1% of adults reported a previous hypertension diagnosis. Less than one third (31.0%) of all interviewed providers demonstrated ability to provide quality hypertension care, and quality varied between provider types (14.8% of private homeopathic, 25.2% of informal, 40.0% of private modern medicine, and 60.0% of public providers gave quality care). While 95.8% of diagnosed individuals received some treatment, only 10.9% of patients received care from quality local providers. Nearly 45% of individuals with hypertension received care from non-local providers. Individuals from the general caste with comorbidities living in villages with more high-quality providers were most likely to receive quality care from a local provider. Whereas the coverage of services for individuals diagnosed with hypertension is high, the quality of these services is suboptimal for economically and socially vulnerable populations, which limits effective management and control of hypertension in rural Bihar. Efforts should be targeted towards providers to initiate quality treatment upon diagnosis, including correct prescription of antihypertensives.
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Peters et al. (2022) conducted a cross-sectional in Hypertension (n=14,386). Hypertension management services was evaluated on Quality-adjusted coverage of hypertension management (receipt of care from quality local providers). Only 10.9% of patients with diagnosed hypertension received care from quality local providers, highlighting significant gaps in effective hypertension management in rural Bihar.
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